[[alternative]]Study of Reducing Central Pain Syndrome for Patients with Spinal Cord Injury by Using Solution-focused Brief Therapy and Multiple Techniques

[[abstract]]本研究探討焦點解決短期諮商取向多元減痛技巧對7位脊髓損傷者建構適宜之工作流程與重要步驟，並且由憂鬱、失志、自我效能與減痛之改善情形，以及四種量表前測和後測結果，做為對照參考。 研究方法包含兩部分:質性部分是以行動研究法建構工作流程。結果發現:焦點解決短期諮商取向多元減痛技巧對此7位脊髓損傷者建構出本研究之減痛工作流程，並且找出十個重要步驟: 1.建立關係、2.確定目標與疼痛量尺評估、3.發大願、4處遇創傷事件的自責與寬恕(用EFTA敲穴道技巧將負面情緒下降，目的為了創造身體正向「例外」經驗)、5.建立正向身體經驗、6.負向量尺減為零(聯想出現其他創傷經驗之處遇)、7.正向認知輸入(用EFTA動眼技巧。目的為了建立自我正向認知:「例外」)、8.量尺分數再評估、9.讚美(隨時有機會即作，不限制依照此排序)、10.回家作業。其中重要步驟1、9與10無法得到個案口頭肯定回應，但是研究者觀察認為個案會在心中思考，對雙方關係和後續改善仍有正向影響，所以仍列為要做之重要步驟。本工作流程，重要步驟4至重要步驟6之間有來回進出、如迴圈重複的部分，可能隨時因為聯想到的事件而應用，插入正常流程當中。 量性部分是以實地實驗法比較兩組前後測的減痛效果。研究結果:14位脊髓損傷者，依照能否有時間諮詢分為兩組。實驗組經介入後，以SPSS 20.0統計分析，量性研究之結果如下:以7位參與介入之實驗組成員與7位控制組成員，以卡方檢定，兩組在工作狀態、受傷部位，達顯著差異。其餘未顯著。實驗組僅一位有工作，控制組七位全有工作。實驗組7位全是頸髓損傷，控制組傷勢較輕，6位胸髓、一位腰髓損傷。根據Mann-Whitney U，發現:實驗組在年齡顯著大於控制組。實驗組平均年齡47.1歲，控制組平均年齡33.1歲。實驗組此三項都顯著居於劣勢。另根據Wilcoxon matched-pairs signed-rank test檢定，發現實驗組前、後測之簡式麥吉爾疼痛量表現在痛量尺、失志量表分數有顯著下降，其他在PHQ、失志、麥吉爾痛感受、總痛量尺、自我效能沒有差異。根據無母數之Mann–Whitney U檢定，發現受試者在介入後的實驗組與控制組的改變量，在PHQ、失志、麥吉爾痛感受、現在痛量尺、總痛量尺、自我效能皆無顯著差異。簡式麥吉爾疼痛量表，兩組前後測差異比，「總痛」為(z=-1.8，p=0.075)。以無母數雙尾檢定:研究假設時，如果設方向性，即實驗組之減痛會比控制組下降更多，若其方向與假設相同時，p值可以除以2(z=-1.8，p=0.038)，因此簡式麥吉爾疼痛量表「總痛」下降達顯著。[[abstract]]Background/Objectives: It is common for Patients with spinal cord injury to have Central Pain Syndrome. This study was aimed at establishing a working flow and finding out the working flow, important issues, steps, and techniques for patients with spinal cord injury by using Solution-Focused Brief Therapy and multiple techniques to reduce pain, depression, demoralization, and to increase self-efficacy. Methods: The research used the mixed method. In the aspect of qualitative research, Action Research was used. In the other aspect, Field Experiment was used as a quantitative research method. Demoralization Scale-Mandarin version, Self-Efficacy Scale-Mandarin version, Patient Health Questionnaire-Mandarin version, and Short-form of McGill Pain Questionnaire-Mandarin version were also used.Results: The important steps of the working flow were as follows. There were 10 steps: 1. Make a cooperative relationship 2. Make sure the goal and evaluate the scale of pain 3. Make a resolution 4. Deal with the blame related to the traumatic events on themselves or others and try to resolve the hurt and forgive themselves and others 5. Establish a positive physical experience 6. Make the scale of the negative emotions and negative beliefs go down to a zero 7. Put in positive beliefs about themselves 8. Evaluate the scale of pain again 9. Praise 10. Assign homework. Although steps 1,9,10 got no response from clients and could not be proved to be effective, according to researcher’s observation, clients will ponder them in their mind and will still have good effect for them later in the future. Furthermore, the data of four standard questionnaires were analyzed with SPSS 20.0, the results were as follows: First, Compared 7 subjects in the experimental group with 7 subjects in the control group, with Chi-square test, working and the place of injury were significant; with Mann-Whitney U, the age was significant. Secondly, With Wilcoxon matched-pairs signed-rank test, compared the differences of scores of 7 subjects in the experimental group only with themselves, pain of now of short form McGill Pain Questionnaire-Mandarin version and demoralization Scale-Mandarin version were lessened significantly. Thirdly, with Mann-Whitney U to compare the differences between two groups, nothing was significant. But in the previous hypothesis, the direction was set that the total pain of the subjects in the experimental group will lower than that of the subjects in the control group. Since the direction of the result was consistent with the hypothesis , the p value can be divided by 2 and become z=-1.8，p=0.038. Therefore, the total pain of short form McGill Pain Questionnaire-Mandarin version, was lowered significantly. Conclusions: Ten important steps were found in the working flow. The effect of using Solution-Focused Brief Therapy and multiple techniques to reduce pain was significant statistically